Quote from purplemania
It is really a sort of mental illness to be a drug-seeker. Do you assess for that?
It might be sort of a mental illness to be a drug seeker, but at 3am, in the ED, it's not a mental illness being addressed, but the 'emergency' that isn't.
Our ED's are not the places to deal with long term, long fix psychiatric problems.
As far as assessing for it: if such pts were interested in seeking treatment for such underlying problems, they wouldn't be in the ED at 3am for a very different kind of 'fix'. The problem is that the need for the fix that brought them to the ED completely obliterates in such pts the ability within themselves to assess for such things.
Drug seekers have a completely misaligned Maslov Hierarchy of needs. For example, we know that it's pointless to address housing situations in people that can't breathe. And it's pointless to address mental health status of people that place the next fix so very much higher on their hierarchy of needs. Simply put, since THEY can't assess for it, it is nigh impossible for US to provide any action for which such assessments would reveal a need. If they don't get what they came for, the vast majority will seek it elsewhere, no matter the rationale and no matter what OTHER treatments are offered.
My first job was at the VA with a drug tx unit. We HAD the option of offering such treatments at no additional cost to our pt populations. My experience: the only pts that benefitted from such options were the ones that came SEEKING such options; not their next fix.
I took care of a pt the other night that left the hospital AMA w/ a bp of 240/140 (because she wouldn't allow the continuation of her nipride gtt). Why? She'd been in long enough to need her next hit of crack and nothing and nobody was gonna stop her from going to get her next fix. I had two choices, tie her down or let her go. And since she was as lucid as her baseline allows, that really eliminates one of the choices. There's a very real distinction between her true needs and her drug warped perception of needs. And no amount of assessing for it will change such perceptions.
I told her point blank, "If you leave, you will likely die, if not tonight, within a few days or weeks. If you stay, you can seek the help that will allow you to see your grandchildren grow up." Response: "I know but I'll be OK". Sigh.